title: Modeling social dimensions of oral health among older adults in urban environments.
abstract: In both developed and developing countries, population aging has attained unprecedented levels. Public health strategies to deliver services in community-based settings are key to enhancing the utilization of preventive care and reducing costs for this segment of the population. Motivated by concerns of inadequate access to oral health care by older adults in urban environments, this article presents a portfolio of systems science models that have been developed on the basis of observations from the ElderSmile preventive screening program operated in northern Manhattan, New York City, by the Columbia University College of Dental Medicine. Using the methodology of system dynamics, models are developed to explore how interpersonal relationships influence older adults' participation in oral health promotion. Feedback mechanisms involving word of mouth about preventive screening opportunities are represented in relation to stocks that change continuously via flows, as well as agents whose states of health care utilization change discretely using stochastic transitions. Agent-based implementations illustrate how social networks and geographic information systems are integrated into dynamic models to reflect heterogeneous and proximity-based patterns of communication and participation in the ElderSmile program. The systems science approach builds shared knowledge among an interdisciplinary research team about the dynamics of access to opportunities for oral health promotion. Using "what if" scenarios to model the effects of program enhancements and policy changes, resources may be effectively leveraged to improve access to preventive and treatment services. Furthermore, since oral health and general health are inextricably linked, the integration of services may improve outcomes and lower costs.
authors.affiliation: 1The State University of New York at Buffalo, Buffalo, NY, USA.
authors.forename: Sara S
authors.initials: SS
authors.lastname: Metcalf
authors.forename: Mary E
authors.initials: ME
authors.lastname: Northridge
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Widener
authors.forename: Bibhas
authors.initials: B
authors.lastname: Chakraborty
authors.forename: Stephen E
authors.initials: SE
authors.lastname: Marshall
authors.forename: Ira B
authors.initials: IB
authors.lastname: Lamster
mesh_terms: D000368:Aged; D003198:Computer Simulation; D016321:Dental Care for Aged / Q000379:methods* / Q000458:organization & administration / Q000706:statistics & numerical data; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006297:Health Services Accessibility; D006801:Humans; D007398:Interpersonal Relations; D008403:Mass Screening / Q000379:methods / Q000458:organization & administration; D008962:Models, Theoretical; D009519:New York City; D009909:Oral Health; D010379:Peer Group; D011156:Population Density; D062206:Spatial Analysis; D013597:Systems Analysis; D014076:Tooth Diseases / Q000175:diagnosis / Q000517:prevention & control*; D014504:Urban Health
keywords: agent-based modeling; aging and health; community health promotion; dynamic modeling; health promotion; social influence; systems science